Rill, 50, needed prompt medical attention. But he hasn't been able to afford health insurance for 15 years. Even when times were better, and he was working at Home Depot, the weekly $75 premium would have eaten up a fifth of his paycheck.

Sound familiar? Florida has the second-lowest rate of health insurance for people younger than 65 in the country, trailing only Texas, a new U.S. Census survey shows. Excluding Medicare-eligible senior citizens, one in four Floridians lives without any form of medical coverage.

Every surveyed city and county in the Tampa Bay area had a lower rate of insured residents than the national average, with the worst rates occurring in Clearwater, Largo and Pasco County. Brandon, with the highest median income, had the most extensive coverage.

The statistics come at a contentious time in the debate over the future of national health care. But experts say Florida's medical problems have compounded for years, elevating the state's private insurance costs to some of the highest in the country.

Consider the demographics. Ours is a state with an aging population, increasing medical demand and a dwindling supply of specialists, making for a highly competitive medical marketplace, said Steven Ullmann, director of programs in health sector management and policy at the University of Miami.

"There are far more for-profit hospitals here than you would see in Massachusetts or New York," Ullmann said. To compete, those hospitals must pay for more and more high-priced technologies. "That competitiveness can, ironically, drive up costs of care," he said.

In fact, Florida has one of the highest Medicare reimbursement rates, according to the Dartmouth Atlas of Health Care. That's a clear sign that spending on health care here is higher for all ages. Insurance costs follow that lead.

Many people in states with large corporate, manufacturing or unionized sectors wouldn't have to worry about the costs, as they can rely on their employers for insurance. But in Florida, with a large swath of the economy in small business and the service sector, employees must find insurance on their own.

"Many small businesses cannot afford to cover that (insurance) as a fringe benefit in the workplace," said Florida State University economics professor Gary Fournier. "So the individual families are left to the private insurance market, which is also very, very expensive and too much of a burden on people with modest means."

Priced out of insurance, people turn to free alternatives like the Clearwater Free Clinic, where the volunteer staff has seen the number of new patients jump 58 percent this year.

Most of the patients work "on a shoestring budget" in jobs such as hairdresser or lawn worker or business owner, and can't afford coverage, said clinic executive director Jeannie Shapiro. And with unemployment on the rise, especially in Florida's once-flourishing fields of real estate and construction, people who once had a job and health coverage now have neither.

"From our experience, the insurance is so expensive," Shapiro said. "If we weren't here, where would all these people go?"

Many end up in the hospital, or in one of its most expensive wards — the emergency room.

At Morton Plant Hospital in Clearwater, 15,000 ER patients, nearly one in four, had no insurance last year, said hospital spokeswoman Beth Hardy.

Tampa General Hospital shares a similar statistic: 22 percent of its total patients are uninsured. "Charity care," what's written off as treatment for uninsured patients on low incomes, accounted for $26 million at Morton Plant Mease's four hospitals in north Pinellas and Pasco counties.

"We have a fair amount of people who come into the ER, and that's their primary care physician," said Steve Short, chief financial officer of Tampa General Hospital. "That is how they access health care."

Hospitals may also deserve some blame for the state's high health costs. Heavy spending in new medical technologies has increased the availability of expensive methods of care — and, consequently, how much they're used.

"Health care providers find they have to distribute the cost of that capital, so they're going to do more procedures than would be called for," Ullmann said, even though, as the Dartmouth Atlas puts it, "higher spending does not result in better quality of care."

"In certain areas, hospitals are stuck in this kind of equilibrium where they end up spending more and earning a lot of business," said University of Miami economics assistant professor Tal Gross.

Top those factors with the state's swelling population of uninsured immigrants and high level of medical fraud, experts said, and the cause behind Florida's low insurance coverage becomes clear. In short: People don't get insured because it's too expensive, and it's too expensive because people don't get insured.

There is a reason why the air in Tampa Bay is filled with playoff talk. If Thursday night's 12-8 Bucs preseason win over the Jaguars is any indication, it's also going to be filled with footballs thrown by quarterback Jameis Winston.